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Chris Steele Optometrist Consultant Head of Optometry Sunderland Eye Infirmary Sunderland

NICE Guideline on diagnosis and management of chronic open angle glaucoma and ocular hypertension: implications for optometry. Chris Steele Optometrist Consultant Head of Optometry Sunderland Eye Infirmary Sunderland. The need for a Guideline.

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Chris Steele Optometrist Consultant Head of Optometry Sunderland Eye Infirmary Sunderland

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  1. NICE Guideline on diagnosis and management of chronic open angle glaucoma and ocular hypertension: implications for optometry Chris Steele Optometrist Consultant Head of Optometry Sunderland Eye Infirmary Sunderland

  2. The need for a Guideline • Chronic diseases which require life long management and monitoring – become a low priority • Patient access targets • Surgical waiting time targets • Fresh demands on existing HES service capacity for urgent delivery of new treatments for blinding eye diseases • Variable standards of care • Cancellations and long delays for follow up visits • Myriads of treatment options and no clear guidance • Over prescribing of potentially harmful drugs • Actual harm to some patients…… • NPSA Rapid Reaction Report June 2009

  3. Diagnosis and monitoring • Consultant ophthalmologist central to care • Diagnosis of COAG and formulation of a management plan should be carried out by a consultant ophthalmologist or someone working under their supervision • e.g. suitably trained optometrists • Lifetime treatment and regular monitoring according to specified risk based intervals are essential elements of care

  4. Monitoring • Where lack of resources make it difficult for regular review…. • The guideline should now aid clinicians to argue more strongly to build up service capacity • NPSA Rapid Reaction Report – June 09 • Action completion 10th December 2009 • has to implemented by law!

  5. Treatment • People with progressive and/or advanced COAG should be offered surgery • Prostaglandins analogue 1st line COAG Rx • Rx of OHT in high risk groups is cost effective in preventing progression to COAG • Therefore identification of high risk groups necessary • People with OHT (whether on Rx or not) monitored according to specified intervals • Context relevant information should be provided

  6. Organisation of care • Many new opportunities for optometrists • A range of health care providers can play a role in caring for people with COAG and OHT • Skill levels specified in accordance with clinical risk and case complexity • Optometrists are well placed and ahead of the game in terms of base line training to take on new roles at every level

  7. Triaging risk • Patients at highest risk of progression remain under supervising care of consultant ophthalmologists • Those at lower risk (OHT) cared for in the community in out-reach settings or by high street optometrists • More cost effective

  8. Guideline implementation • The properly managed implementation period advised by NICE is 3 years • (or 5 in exceptional circumstances) • Scope of the guideline is DIAGNOSIS and MANAGEMENT of COAG and OHT • Screening and case finding specifically excluded

  9. Impact of the guideline • The NICE guideline and advice from AOP has dramatically increased referrals to HES • Professional indemnity issues • Contractual issues re: repeat measures • AOP stance may well affect future relationships between optometrists and their colleagues in both commissioning and secondary care • AOP stance undermines optometrists in terms of their ability to be seen as responsible clinicians capable of extending their roles into areas of clinical work where mature, sensible patient focussed judgements must sit alongside innate uncertainties faced in every day practice

  10. LOC Support Unit - LOCSU • “Glaucoma Referral Refinement and OHT Enhanced Service Pathways following updated NICE guidance” • May 2009 • Gives clear and accurate account of which services could and should be provided • Well aligned to NICE guideline

  11. Impact of the guideline • PCTs & PBC consortia should ensure community based specialist optometry services are available • Triage referrals or carry out recommended specialist assessments to define whether a consultant ophthalmologist opinion is needed • PBC leads, PCT commissioners, community optometrists and ophthalmology consultants should agree a local care pathway to ensure patients with OHT and COAG receive cost effective/efficient care in line with Guidance

  12. Conclusions • Important step forward in raising the standards of care for people at risk of vision loss from glaucoma. • Improve the chances of a sighted life time for those with COAG, OHT and suspect COAG • Evidenced based treatments and timely monitoring • Integrated care pathways with many opportunities for optometrists • By implementing this guideline more people will be prevented from going blind

  13. Thank you For listening

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